Referring Doctors

For Physicians

Patient Referral Form

York Dermatology Clinic & RC is a specialist clinic, and medical patients require a referral from a family doctor or walk-in clinic. Submit your referral online below, or download the referral form and fax it to (905) 883-7994. We accept referrals for:

Dermatology

Hidradenitis Suppurativa Clinic (Dermatologist + Surgeon)

Rheumatology

Allergist/Immunologist

How to Refer a Patient

Refer Online

Complete the online referral form on this page. Fields marked with an asterisk (*) are required.

Fax the Referral Form

Download the PDF, complete it, and fax it to (905) 883‑7994.

Urgent Referrals

For consultation needed in less than 3 days, please email info@yorkderm.ca.

Online Referral Form

Complete the referral below and submit it to our office. Fields marked with an asterisk (*) are required. Once we receive the referral, we will contact the patient directly to schedule an appointment.

Patient Demographics

Referral Date

Patient Name

First

Last

Date of Birth

Sex

Health Card (HC) Number

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Work Phone

Cell Phone

Reason of Referral

Referral for

Dermatology
Hidradenitis Suppurativa Clinic (Dermatologist + Surgeon)
Rheumatology
Allergist/Immunologist

Presenting Problem

Relevant Past Medical History & Allergies

Referring Doctor Information

Referring Physician

Billing Number

for Address Sex

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Fax

Prefer to Fax?

Download the PDF Referral Form

Download and complete the referral form, then fax it to our office. Once we receive the referral, we will contact the patient directly to schedule an appointment.

Fax: (905) 883-7994
Phone: (905) 883-7997
Urgent referrals (consultation needed in less than 3 days): info@yorkderm.ca

Questions About a Referral?

Call us at (905) 883-7997, Monday to Friday, 8:30 AM to 4:30 PM, or fax referrals to (905) 883-7994. For urgent matters requiring consultation in less than 3 days, please email info@yorkderm.ca.

Location

Visit Our Richmond Hill Clinic

York Dermatology Clinic & RC
245 West Beaver Creek Rd., Unit 2
Richmond Hill, Ontario L4B 1L1

Phone: (905) 883-7997
Fax: (905) 883-7994

Monday – Friday: 8:30 AM – 4:30 PM
Saturday & Sunday: Closed